Thursday, January 28, 2010

Keep ME WellGovernor Baldacci, in his State of the State Speech and in a January 27th press conference, launched the Keep ME Well initiative. This novel tool helps people to assess their health risks, to obtain a report that helps them take action and find local resources and support in their own communities, and to find low-cost health care services. This will be a very useful web site for health care providers and their patients. Check it out at http://bit.ly/bJRAHK

2010 District Health Indicator Tables are posted!In 2008, Maine CDC published tables comparing major health indicators for each of the 8 public health districts, Maine, and the U.S. These tables have just been updated and include additional indicators such as some on preventable hospitalizations by district and cost data associated with them. District data that are significantly different than the state data are yellow highlighted. Both the 2008 and 2010 tables along with the data resources used can be found under “Health Indicator Comparison Tables” on the upper left hand side of our homepage (http://bit.ly/ciXQkx) or directly at http://bit.ly/9d2FJj. We hope you find these tables useful.

Group A StrepMaine CDC issued a health advisory last week to health care providers on an increase in the number and severity of invasive Group A Streptococcal (GAS) infections seen in January in Maine. Since then, additional cases have been identified, bringing the total thus far this month to ten, with an age range of 15 – 90 years-old. Four of these have resulted in Streptococcal Toxic Shock Syndrome (STSS), of which three have died. Although GAS is a common bacteria in the throat and skin, often causing strep throat or impetigo, invasive GAS disease is rare, with the five-year median in Maine being 19 cases per year. More information, including recommendations, can be found in last week’s health advisory at: http://bit.ly/bswpU2 or visit this US CDC web site: http://bit.ly/cP0vIl.

Earthquakes and Public HealthThere are many public health concerns as a result from earthquakes, including those related to victims of the disaster and those related to people traveling to post earthquake zones such as Haiti to assist in recovery efforts. The US CDC’s earthquake website has helpful information for those who may be involved with the Haiti relief efforts or who are interested in improving their preparations here at home.http://www.bt.cdc.gov/disasters/earthquakes/

Influenza Activity in Maine and the USThere were no new confirmed cases of H1N1 influenza reported in Maine last week. However, 10 people in Maine have been hospitalized due to H1N1 since the beginning of this month, including four children. Of those hospitalized, three required admission to an intensive care unit, including one child and one young adult. Only one of those hospitalized was fully vaccinated and only two had received early antiviral medicines, despite risk factors for severe disease. These hospitalizations are reminders of the importance of health care providers offering H1N1 flu vaccine to every patient at every encounter. Vaccination against influenza and early detection with prompt treatment are still very important, especially for those at risk for complications. We expect to see the pandemic form of H1N1 to circulate for months to come. We have not yet detected any seasonal influenza virus in samples submitted for testing this winter, and there have been no outbreaks of seasonal flu reported in other parts of the country. Vaccine can still be found in a number of public clinics, including many that are offering it for free. These can be located by calling 211 or by visiting http://bit.ly/5xdkVe. The free clinics are in bold font.

Messages to the Public• Many people are still susceptible to this virus and would benefit from vaccination. Being vaccinated not only protects you, but it helps protect the people around you who are more likely to suffer serious complications from the flu.• To find a vaccine, call your health care provider, or get the list of public vaccine clinics by calling 211 from 8 a.m. to 8 p.m. or visiting www.maineflu.gov (all clinics posted in bold are free).• If you think you have the flu, cannot reach your doctor, and/or your health plan does not have a nurse call line available, you may call 2-1-1 from 8 a.m. to 8 p.m. to be connected with a health professional who can assess your symptoms.

Thursday, January 21, 2010

Flu Activity in Maine and the USWe continue to see H1N1 circulate in Maine, though at declining levels from a month ago. This last week there were two new hospitalizations, one of whom required intensive care. Since the beginning of January, 10 Mainers have been hospitalized for H1N1, including four children. Of those hospitalized, three required admission to an intensive care unit, including one child and one young adult. We are finding an increasing number of hospitalized patients who have neither been vaccinated nor received early treatment with antiviral medicines. Vaccination against influenza and early detection of infection with prompt treatment are still important, especially for people at risk of complications. These cases are also a reminder that we expect to see the pandemic form of H1N1 influenza virus to continue to circulate for months to come, so it is important to keep H1N1 in the differential for people presenting with symptoms.

We have not yet detected any seasonal influenza virus in samples submitted for testing this winter, and there have been no reported outbreaks of seasonal influenza in other parts of the country as well.

H1N1 Vaccine SupplyThere is now plenty of vaccine in Maine, with about 800,000 doses of H1N1 vaccine distributed statewide since October. Maine CDC is now processing orders for H1N1 vaccine the same day the request comes in from a health care provider, with about a four-day turnaround between order and receipt of vaccine.

About 500 health care providers in the state have received H1N1 vaccine. We strongly urge health care providers to offer the H1N1 flu vaccine to every patient at every encounter.

Public clinics can be located by calling 211 or visiting www.maineflu.gov. There are many clinics that are offering free vaccine, identified by the bold font on the website.

December 2009 National Survey of H1N1 and Seasonal Flu Vaccine CoverageUS CDC has released data from a national survey conducted through much of December on H1N1 and seasonal flu vaccine coverage. Maine stood out as having an H1N1 vaccine rate among children that is more than twice the national average – 60% versus 28%. Although we do not know our formal ranking, we know only 4 states had pediatric coverage rates of over 40%.

Maine also had higher rates of H1N1 vaccine in health care personnel working with high-risk patients (46% vs. 27% nationally) and of seasonal flu vaccine coverage among children (52% vs. 34% nationally).

Main Messages to the PublicMany people are still susceptible to this virus and would benefit from vaccination. Being vaccinated not only protects you, but it helps protect the people around you who are more likely to suffer serious complications from the flu.To find a vaccine, call your health care provider, or get the list of public vaccine clinics by calling 211 from 8 a.m. to 8 p.m. or visiting www.maineflu.gov (all clinics posted in bold are free).If you think you have the flu, cannot reach your doctor, and/or your health plan does not have a nurse call line available, you may call 2-1-1 from 8 a.m. to 8 p.m. to be connected with a health professional who can assess your symptoms.

Tuesday, January 19, 2010

Below is a wonderful tribute to Dr. Martin Luther King, Jr., written 10 years ago by the then head of US DHHS' AHRQ. About a year after this was published, Dr. John Eisenberg was diagnosed with an aggressive brain cancer, and died in 2002. I think this piece is a wonderful tribute to both men we were so fortunate to have on this planet, though for too short a time. Dora

Birthday Observance of Dr. Martin Luther King, Jr. Remember! Celebrate! Act! A Day On, Not a Day Off!John M. Eisenberg, MD, Director, Agency for Healthcare Research and Quality, January 14, 2000

When I was invited to welcome you to the Department of Health and Human Service's 26th observance of Martin Luther King, Jr.'s birthday, my first thought was about how honored I was to be asked. My second thought was about what Martin Luther King's birth could mean to a rebirth of health care in this country. Few have had as much impact upon the American consciousness.

But what did Martin Luther King, Jr. think about health care?

My colleagues and I searched through his writings and his speeches, and realized that he didn't give speeches about health care. Martin Luther King, Jr. was confronting the basic nature of American society. He had mountains to move—and mountaintops to climb—for this country so that today we can address the issues of high quality health care for all Americans.

If Dr. King were alive today he'd be 71 years old. He'd be eligible for Medicare. Like many 71-year-olds, he might be dealing with a chronic medical condition—maybe arthritis, or hypertension, or diabetes. What would he think of the health care system we have today? What would he think of the medical care he might receive? And what advice would he be giving the Department of Health and Human Services?

No, Dr. King didn't give many speeches about health care. But like the rest of society, health care had to change too.

When I was a teenager in Memphis, before the Medicare program was passed, the Baptist Hospital was the biggest in town, and the proudest of the care it gave. But if you were African-American in Memphis and you went to the Baptist Hospital, you'd go in through a back entrance. And you'd go to a segregated ward, where you would be in a big room with about 15 or 20 other people. And your doctor, if he was black, would not have privileges on staff. And the same would have been true for Dr. King in Montgomery or in Atlanta.

Dr. Vanessa Gamble, who is the new director of minority affairs at the Association of American Medical Colleges here in Washington, has documented the incredibly important role that Medicare and Medicaid played in helping to desegregate hospitals. Medicare was a lever that lifted equity and equality in hospitals. In 1965, our Department issued regulations mandating that hospitals had to be in compliance with Civil Rights Act—which had been passed just the year before—in order to be eligible for Federal assistance or to participate in any federally assisted program. The passage of Medicare and Medicaid legislation that year made every hospital a potential recipient of federal funds, and therefore obligated every hospital to comply with civil rights legislation if they wanted to get paid.

The law changed, but practice was slower.

When I was a medical student in St. Louis, at Barnes Hospital around 1970, researchers asked why the hospital still seemed to be segregated. Why? Because clerks in the admissions office—both black and white—were so accustomed to the old ways that they continued to admit the races to their old units. The law had changed, but racial stereotypes had remained. Racist practices were illegal, but racism was institutionalized, and the seeds of racism grew into practices that amounted to discrimination.

I ask you, is it any different today, 31 years after Dr. King was shot in my hometown, and we grieved over the loss of a great American? Is it different 31 years after I was ashamed of the symbol that my hometown had become, when all that Dr. King wanted was to put into practice the placards that the Memphis sanitation workers wore, that read, "I am a man"?

Today, research shows that African-Americans are one-third less likely to have coronary bypass surgery than whites with the same conditions. Why? And today, African-Americans with HIV are less likely to receive antiviral treatment. Why do these disparities occur?

The easy answer is that it is because African-Americans are more often uninsured. And that is true. But even with the same insurance, African-Americans don't have the same access to primary care doctors, specialists and hospitals. And most distressing, even with the same insurance and being cared for at the same hospitals, African-Americans get different care. In one study I did, if you were a black woman you were much less likely to get referred for cardiac catheterization.

The reason—I fear—is that, despite Dr. King's advances, and despite civil rights laws, and despite Medicare, racism is a part of the institution of American life, and the seeds of racism still grow into discriminatory practices.

So, now 31 years after Dr. King's death and 35 years after Medicare broke down segregated wards in the nation's hospitals, the question for us is: What can we do today in our Department to eliminate these disparities, whether they grow out of lack of insurance, lack of access, or lack of quality care for those who get access?

No matter where we work in this Department—

At the Health Care Financing Administration, where care is funded.

At the Health Resources and Services Administration, where programs are supported to help access.

At the Food and Drug Administration, where safe drugs are assured.

At the National Institutes of Health, where research can identify the causes of disease.

At the Agency for Healthcare Research and Quality, where we find out why the quality of care isn't what it can be, and where our name itself speaks of an arc, of closing gaps.

In every operating and staff division—

We can use the levers that we are so lucky to have, and so privileged to use, to eliminate the barriers to high quality health care.

Because we shall overcome.

We shall overcome the disparities in health care, whether they are due to economic barriers, or institutionalized racism, or even unconscious discrimination. We—as public servants—can build on Dr. King's contribution to the moral health of our country to make our own contributions to the physical and mental health of all of its people.

Birthday Observance of Dr. Martin Luther King, Jr.: Remember! Celebrate! Act! A Day On, Not a Day Off! Opening Remarks by John M. Eisenberg, M.D., Director, Agency for Healthcare Research and Quality, January 14, 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/mlkspch.htm

This US CDC website is very useful for earthquake preparedness. Believe it or not, we have them in Maine on occasion, and certainly many Mainers frequently travel to zones of higher earthquake activity. It also has good information for those who may be traveling to Haiti to assist in the recovery efforts there, including which vaccines to obtain and what other health issues to be concerned about.

Thursday, January 14, 2010

Flu Activity in Maine and the USWe continue to see H1N1 in Maine, including three new hospitalizations this week – one in a child younger than 5, another child younger than 18, and an adult in the 50-64 age range. There was also an outbreak of H1N1 at a long term care facility. Although H1N1 flu activity has decreased in Maine in recent weeks, there have been increases in H1N1 illness in other areas of the U.S.

Many people are still susceptible to this virus and would benefit from vaccination. Being vaccinated not only protects you, but it helps protect the people around you who are more likely to suffer serious complications from the flu.

Flu is unpredictable, but it often comes in waves. There was a mild surge in the spring of 1957, followed by a large surge in the fall, another large one in the winter of 1958, and others following that with the virus circulating for several years. All pandemics are different, but most have multiple waves of illness and death.

H1N1 Vaccine SupplyThere is now plenty of vaccine in Maine, so it’s an excellent time for people who have not been vaccinated against H1N1 and seasonal flu to do so before the next wave of disease. Nearly 800,000 doses of H1N1 vaccine have been distributed statewide since October. Close to 500 health care providers in the state have received H1N1 vaccine. Call your health care provider, or get the list of public vaccine clinics by calling 211 from 8 a.m. to 8 p.m. or visiting www.maineflu.gov (all clinics posted in bold are free).

Maine CDC recommends that health care providers offer H1N1 vaccine to every patient at every visit, every hospitalization, or other health care encounter, assuming contraindications do not exist.

If you think you have the flu, cannot reach your doctor, and your health plan does not have a nurse call line available, you may call 2-1-1 from 8 a.m. to 8 p.m. to be connected with a health professional who can assess your symptoms.

Information for People with Chronic Underlying Health ConditionsPneumonia, bronchitis, acute respiratory distress syndrome, sinus infections and ear infections are examples of flu-related complications. The flu can also make chronic health problems worse. H1N1 has caused more deaths among adults with chronic medical conditions than in any other group. All 18 H1N1-related deaths in Maine have been in adults with chronic underlying conditions.

If you have a high-risk condition, getting vaccinated is the single best action you can take to protect yourself from the flu. Still, most adults with high-risk conditions have not been vaccinated yet. Many people in these groups do not realize that their medical conditions increase their risk. The following conditions put people are risk for flu-related complications:· asthma;· heart disease· chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis);· diabetes and other endocrine disorders;· neurological or neurodevelopmental disorders, and especially those that affect lung capacity (muscular dystrophy, cerebral palsy, strokes, etc);· blood disorders, such as sickle cell disease;· kidney and liver disorders;· weakened immune system due to disease or medication, such HIV/AIDS, cancer, or steroids;· long-term aspirin therapy in people younger than 19.

If you have a chronic health condition and have not yet received your vaccine against H1N1, get one now. Contact your health care provider, specialist, call 2-1-1 from 8 a.m. to 8 p.m. for a list of public clinics, or check www.maineflu.gov (clinics listed in bold are free).

If you have an underlying health condition and experience flu-like symptoms, contact your health care provider immediately to receive a prescription for antiviral medications (such as Tamiflu®).

Tuesday, January 12, 2010

It’s National Influenza Vaccination Week, and although H1N1 flu activity has decreased in recent weeks, people in Maine and across the country are still being hospitalized and dying from influenza.

All 18 deaths due to H1N1 flu in Maine since August have been among people with underlying health conditions. If you have a high-risk condition, getting vaccinated is the single best action you can take to protect yourself from the flu.

Flu is unpredictable, but it often comes in waves. Now is an excellent time for people who have not been vaccinated against H1N1 and seasonal flu to do so before the next wave of disease. Vaccine is widely available in Maine now. Call your health care provider, or get the list of public clinics by calling 211 from 8 a.m. to 8 p.m. or visiting www.maineflu.gov(all clinics posted in bold are free).

If you have an underlying health condition and experience flu-like symptoms, contact your health care provider immediately to receive a prescription for antiviral medications (such as Tamiflu®).

Thursday, January 7, 2010

Flu Activity in Maine and the USFlu activity in Maine has decreased enough to be classified as “regional” instead of “widespread.” However, people are still being hospitalized due to H1N1, and it is important to be aware that flu comes in waves. Vaccination is the best protection for yourself and the people you care about.

An Aroostook County resident in the 50 to 64 age group died earlier this week in part due to complications related to H1N1. The deceased was diagnosed with H1N1 in mid-December and had multiple serious underlying conditions. (This death was reported to Maine CDC after the surveillance information at the end of this report was compiled, and therefore will not be reflected in that data at the end of this update.)

All 18 deaths due to H1N1 since August have been among people with underlying health conditions, which emphasizes the importance of getting vaccinated if you have a high-risk condition, including asthma, emphysema, diabetes, heart disease, kidney and liver disorders, neurological disorders, blood disorders, cancer, HIV or AIDS, and others.

There were 5 new hospitalizations due to H1N1 last week, up from 3 the week before. Two children under age 18 were hospitalized, with one in intensive care; one young adult under age 24 was hospitalized and in intensive care; and two adults under age 65 were hospitalized. Hospitalizations occurred in Aroostook, Hancock, and Penobscot counties.

Vaccine is widely available, and we encourage everyone to be vaccinated. Information on flu vaccine clinics, including many free ones, is available by calling 211, checking www.maineflu.gov (free ones in bold font) or by contacting one’s health care provider.

H1N1 Vaccine Supply and PrioritizationNearly 800,000 cumulative doses of H1N1 vaccine have arrived in Maine since October, which is an increase of 300,000 in just the last 2 ½ weeks. Maine CDC is able to meet the demand for vaccine, so if a health care provider needs more vaccine, they should order additional doses, as per the instructions below. We recommend health care providers offer H1N1 vaccine to every patient at every visit, every hospitalization, or other health care encounter, assuming contraindications do not exist. Such strategies as standing orders and adding H1N1 vaccine status to intake and discharge questions are appropriate to consider. It is important to take advantage of this window of opportunity (declining disease burden and expanded vaccine supply) to encourage vaccine.

There is an abundant supply of nasal spray vaccine in the state. We request that nasal spray vaccine be given to anyone who is eligible to receive it. The nasal spray vaccine is a safe and effective vaccine option for healthy people ages 2 through 49 years old who are not pregnant. For more information on nasal spray vaccine, please see our Fact Sheet at: http://www.maine.gov/dhhs/boh/maineflu/LAIV_factsheet.pdf.

Important Information for Vaccine AdministratorsVaccination is the best way to protect patients and to slow down the circulation of the virus, which may also help to prevent unwanted changes in the virus. Maine CDC encourages all appropriately licensed health care providers to register for, order, and offer H1N1 vaccine to their patients, including those health care providers in non-traditional settings for vaccine, such as specialists and those providing care for populations who may not seek vaccine, such as those with serious mental illness.

If a health care provider is already registered but is running low on H1N1 vaccine, the provider should:Confirm that you have placed orders for all the vaccine you need. You may order more by completing this form: http://www.maine.gov/dhhs/boh/maineflu/h1n1/hc-providers/h1n1-vaccine-orderform.shtml.It often takes 7-10 days to replenish a health care provider’s vaccine supply. If you have acute vaccine needs or other related concerns or questions, email flu.questions@maine.gov or call the Immunization Program at: 287-3746 or toll free at 1-800-867-4775 Monday – Friday 8 am – 5 pm.

If local vaccine supplies are not sufficient while awaiting more vaccine, Maine CDC recommends focusing the limited supply on those patients in the five high priority groups (pregnant women, people ages 6 months through 24 years-old, people 25 through 64 years-old with an underlying medical condition, caregivers and household contacts of infants younger than 6 months, and health care workers). Patients can also be referred to public clinics which can be found by calling 211 or checking http://www.maineflu.gov/.

Health care providers who have too much vaccine should contact their local Vaccine Coordinator to arrange for redistribution.

Vaccine Return:The only vaccines that should be returned are those that arrive non-viable or appear to be damaged during transit. Providers with concerns about vaccine viability during transit from the McKesson Distributor should call 877-836-7123 immediately upon receipt of the package.

Once a provider takes receipt of the vaccine as a usable product, it is that provider’s responsibility to ensure proper disposal of any damaged, expired, or un-used vaccine unless it has been recalled. Health care providers who have sufficient supplies and no longer need vaccine they receive should contact their local vaccine coordinator (listed above) to arrange for redistribution.

Changes in Ancillary Supply Kits:As supplies of Influenza Vaccination Record cards are exhausted, US CDC will no longer be including these cards in shipments of H1N1 vaccine. Within a single shipment, cards could be included with one type of vaccine and not others.

Vaccinating Small ChildrenThe 0.25 mL pre-filled syringe presentation of vaccine for children ages 6-36 months will no longer be available for order. Maine CDC makes the following recommendations for vaccinating small children:Use the Sanofi or CSL multidose vial for all children ages 6 months to two years of ageUse the nasal spray vaccine for healthy children ages two years and older, when available and appropriateUse the Sanofi or CSL multidose vial for children ages two and older who are not eligible to receive nasal spray vaccine, or when nasal spray is unavailable

Seasonal Flu VaccineMaine CDC’s Immunization Program has filled all of its orders for seasonal flu vaccine, and is unable to place additional orders for vaccine. Most seasonal flu vaccine in the state is ordered privately and is not under the control of Maine CDC.

US CDC continues to encourage those at highest risk from flu complications to seek seasonal flu vaccine and receive H1N1 vaccine, as recommended. People ages 65 and older at highest risk for complications from seasonal flu. Others are high risk for complications from seasonal flu include pregnant women, children younger than 2 years-old, and people with underlying health conditions. If you fall into one of these groups and have not been able to locate vaccine, check with your health care provider or look for seasonal flu clinics listed at http://www.maineflu.gov/ and with 211.

Conference Call for Partners Holding Public Vaccine ClinicsA conference call to address questions regarding expectations of partners who have agreed to host H1N1 vaccine clinics and receive funding from Maine CDC to support those efforts will be held at noon on Monday, Jan. 11. The call-in number is 1-800-244-5901 with the pass code 749239. This call will focus on the development of some concrete ideas for how to meet the objectives of funding provided to partners, and approaches to develop and implement plans for administration of vaccine to broad populations statewide. Representatives of hospitals, health centers and schools will be invited to join this discussion. During calls, please press *6 to mute your line un-mute when you are actively participating.

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